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What Does Carcinoma In Situ Of Bladder Mean

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Prognosis And Survival For Bladder Cancer

What is Carcinoma in situ? – Pathology mini tutorial

If you have bladder cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.

The following are prognostic and predictive factors for bladder cancer.

Stage Of Cancer Carcinoma In Situ And Additional Terms

A common question is, “What stage of cancer is carcinoma in situ?” Carcinoma in situ is referred to as stage 0 cancer. At this stage, cancer is considered non-invasive. Stage 1 cancers and beyond are considered invasive, meaning that even if low, there is a potential they could spread. Other terms that may be used in defining the same thing as carcinoma in situ or stage 0 cancer include:

  • Non-infiltrating
  • Intra-epithelial

Diagnosis Of Serous Tubal Intraepithelial Carcinoma

Serous Tubal Intraepithelial Carcinoma is now recognized to be the precursor lesion of most so-called ovarian high-grade serous carcinomas. p53 and Ki67 immunostaining is useful in the diagnosis of STIC and its distinction from benign reactive tubal epithelial lesions. In the presence of convincing high-grade nuclear atypia involving the fallopian tube mucosa, the presence of abnormal p53 immunostaining and a high Ki67 labeling index support a diagnosis of STIC . The use of these markers in routine diagnosis has been advocated because the interobserver reproducibility of the diagnosis of STIC on morphology is, at most, moderate. Fallopian tube mucosal involvement by uterine or nongynecologic primary tumors can occur and mimic STIC. WT1 may be of value in these cases since STIC is WT1 positive and other carcinomas are generally negative.

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What Are The Treatment Options For Bladder Cancer

There are four types of treatment for patients with bladder cancer. These include:

  • Surgery

Sometimes, combinations of these treatments will be used.

Surgical options

Surgery is a common treatment option for bladder cancer. The type of surgery chosen will depend on the stage of the cancer.

  • Transurethral resection of the bladder is used most often for early stage disease . It is done under general or spinal anesthesia. In this procedure, a special telescope called a resectoscope is inserted through the urethra into the bladder. The tumor is then trimmed away with the resectoscope, using a wire loop, and the raw surface of the bladder is then fulgurated .
  • Partial cystectomy is the removal of a section of the bladder. At times, it is used for a single tumor that invades the bladder wall in only one region of the bladder. This type of surgery retains most of the bladder. Chemotherapy or radiation therapy is often used in combination. Only a minority of patients will qualify for this bladder-sparing procedure.
  • Radical cystectomy is complete removal of the bladder. It is used for more extensive cancers and those that have spread beyond the bladder .

This surgery is often done using a robot, which removes the bladder and any other surrounding organs. In men, this is the prostate and seminal vesicles. In women, the ovaries, uterus and a portion of the vagina may be removed along with the bladder.

Chemotherapy

  • Methotrexate

Intravesical therapy

Radiation therapy

Electromotive And Hyperthermic Therapy With Mitomycin C

Definition of carcinoma in situ

Electromotive drug administration is based on the enhancement of intravesical chemotherapy transport with a current gradient between the drug and bladder wall. Acceleration of mitomycin C transport with electromotive therapy was investigated in a prospective randomized study . A total of 108 patients with CIS were randomized to three arms after transurethral resection and multiple biopsies: electromotive MMC instillation, passive MMC instillation, or BCG instillation. Complete response at 6 months was observed in 31% of passive MMC patients, 58% of electromotive MMC patients, and 64% of BCG patients. A subsequent randomized controlled trial investigated the comparison of BCG alone with sequential BCG and electromotive MMC for high-risk NMIBC . Patients received either induction BCG or BCG for 2 weeks followed by three cycles of weekly electromotive MMC. In 212 patients, the disease-free survival was 69 months versus 21 months in BCG plus electromotive MMC and BCG alone, respectively. Recurrence was also significantly lower in BCG plus electromotive MMC than BCG alone at 41.9% versus 57.9%, respectively. In addition, with the recent announcement of BCG shortage, electromotive MMC has emerged as a potential alternative to intravesical therapy . Although this is an option in Canada and other countries, it is not currently available in the United States.

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Looking For More Of An Introduction

If you would like more of an introduction, explore this related item. Please note that this link will take you to another section on Cancer.Net.

  • ASCO Answers Fact Sheet:Read a 1-page fact sheet that offers an introduction to bladder cancer. This free fact sheet is available as a PDF, so it is easy to print.

Bcg Immunotherapy For Transitional

Donald L. Lamm, MDOncology

Prior to the advent of BCG immunotherapy, bladder carcinoma in situ often progressed to muscle invasion. Intravesical chemotherapy completely eradicates the disease in 50% of patients, but fewer than 20% remain disease free after 5 years. Complete responses have been reported in 70% or more of BCG treated patients, nearly two-thirds of which are durable.

Prior to the advent of BCG immunotherapy, bladder carcinoma in situ often progressed to muscle invasion. Intravesical chemotherapy completely eradicates the disease in 50% of patients, but fewer than 20% remain disease free after 5 years. Complete responses have been reported in 70% or more of BCG treated patients, nearly two-thirds of which are durable. Controversy over the optimal induction and maintenance regimens for BCG immunotherapy remain, but SWOG investigators have demonstrated that complete response rates can be increased from the expected 73% to 87% with just three additional BCG instillations given at 3 months. In complete responders, maintenance BCG using three weekly treatments at 6-month intervals improves long-term complete response rates from 65% to nearly 90%. Caution must be exercised to avoid serious side effects.

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What Are The Stages Of Bladder Cancer

Bladder cancer can be either early stage or invasive .

The stages range from TA to IV . In the earliest stages , the cancer is confined to the lining of the bladder or in the connective tissue just below the lining, but has not invaded into the main muscle wall of the bladder.

Stages II to IV denote invasive cancer:

  • In Stage II, cancer has spread to the muscle wall of the bladder.
  • In Stage III, the cancer has spread to the fatty tissue outside the bladder muscle.
  • In Stage IV, the cancer has metastasized from the bladder to the lymph nodes or to other organs or bones.

A more sophisticated and preferred staging system is known as TNM, which stands for tumor, node involvement and metastases. In this system:

  • Invasive bladder tumors can range from T2 all the way to T4 .
  • Lymph node involvement ranges from N0 to N3 .
  • M0 means that there is no metastasis outside of the pelvis. M1 means that it has metastasized outside of the pelvis.

About The Bladder Renal Pelvis Ureter And Urethra

Ductal Carcinoma In Situ

The bladder is a hollow organ in the pelvis that stores urine before it leaves the body during urination. This function makes the bladder an important part of the urinary tract. The urinary tract is also made up of the kidneys, ureters, and urethra. The renal pelvis is a funnel-like part of the kidney that collects urine and sends it into the ureter. The ureter is a tube that runs from each kidney into the bladder. The urethra is the tube that carries urine out of the body. The prostate gland is also part of the urinary tract.

The bladder, like other parts of the urinary tract, is lined with a layer of cells called the urothelium. This layer of cells is separated from the bladder wall muscles, called the muscularis propria, by a thin, fibrous band called the lamina propria.

Bladder cancer begins when healthy cells in the bladder liningmost commonly urothelial cellschange and grow out of control, forming a mass called a tumor. Urothelial cells also line the renal pelvis and ureters and urethra. Cancer that develops in the renal pelvis and ureters is also considered a type of urothelial cancer and is often called upper tract urothelial cancer. In most cases, it is treated in much the same way as bladder cancer and is described in this guide. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. Benign bladder tumors are very rare.

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What Are The Types Of Bladder Cancer Tumors That May Form

Three types of bladder cancer may form, and each type of tumor can be present in one or more areas of the bladder, and more than one type can be present at the same time:

  • Papillary tumors stick out from the bladder lining on a stalk. They tend to grow into the bladder cavity, away from the bladder wall, instead of deeper into the layers of the bladder wall.
  • Sessile tumors lie flat against the bladder lining. Sessile tumors are much more likely than papillary tumors to grow deeper into the layers of the bladder wall.
  • Carcinoma in situ is a cancerous patch of bladder lining, often referred to as a flat tumor. The patch may look almost normal or may look red and inflamed. CIS is a type of nonmuscle-invasive bladder cancer that is of higher grade and increases the risk of recurrence and progression. At diagnosis, approximately 10% of patients with bladder cancer present with CIS.

What Is Bladder Cancer

Bladder cancer starts when cells that make up the urinary bladder start to grow out of control. As more cancer cells develop, they can form a tumor and, with time, spread to other parts of the body.

The bladder is a hollow organ in the lower pelvis. It has flexible, muscular walls that can stretch to hold urine and squeeze to send it out of the body. The bladder’s main job is to store urine. Urine is liquid waste made by the 2 kidneys and then carried to the bladder through 2 tubes called ureters. When you urinate, the muscles in the bladder contract, and urine is forced out of the bladder through a tube called the urethra.

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Risk Groups For Early Bladder Cancer

Doctors put early bladder cancer into 3 risk groups. These groups describe how likely it is that your cancer will spread further, or come back after treatment.

The 3 risk groups are:

  • low risk
  • intermediate risk
  • high risk

Your doctor tells you whether your cancer is low risk, intermediate risk or high risk. Knowing your risk group helps them decide which tests and treatment are best for you.

Your risk group depends on:

  • the size of your tumour
  • what the cells look like under a microscope
  • how many tumours there are
  • the type of bladder tumour
  • whether you have had treatment in the last year for early bladder cancer

Carcinoma In Situ Of The Bladder

Carcinoma In Situ Meaning : AGO 2020: " Duktales Carcinoma in situ (DCIS ...

Carcinoma in situ of the bladder was first described in 1952 by Melicow . The diffuse nature of CIS was demonstrated in a subsequent report of 30 cases in which CIS extended from the renal pelvis to the penile urethra . Carcinoma in situ may occur as a primary disease, in association with papillary or solid tumors, or following tumor resection.

Irritative symptoms are common in patients with primary or concurrent CIS . Hematuria also is a frequent presenting feature. Urinary cytology is positive in more than 90% of patients with CIS and is an important diagnostic procedure because cystoscopic findings and even bladder biopsy may be falsely negative.

Clinical Course

The clinical course of CIS is highly variable, but overall, prior to the advent of BCG immunotherapy, 54% of patients progressed to muscle-invasive disease . Extensive, diffuse disease is considered to pose an increased risk for progression, whereas focal disease may exist for years and has a reported incidence of progression as low as 8% .

Focal CIS is the earliest stage in the evolution of invasive bladder cancer, and although its course is often protracted, regression virtually never occurs. Patients with focal disease are optimal candidates for intravesical therapy.

Radiation and Systemic Chemotherapy

Intravesical Chemotherapy

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What Are The Risk Factors For Bladder Cancer

Some factors increase the risk of bladder cancer:

  • Cigarette smoking is the biggest risk factor it more than doubles the risk. Pipe and cigar smoking and exposure to second-hand smoking may also increase one’s risk.
  • Prior radiation exposure is the next most common risk factor .
  • Certain chemotherapy drugs also increase the risk of bladder cancer.
  • Environmental exposures increase the risk of bladder cancer. People who work with chemicals, such as aromatic amines are at risk. Extensive exposure to rubber, leather, some textiles, paint, and hairdressing supplies, typically related to occupational exposure, also appears to increase the risk.
  • Infection with a parasite known as Schistosoma haematobium, which is more common in developing countries and the Middle East.
  • People who have frequent infections of the bladder, bladder stones, or other diseases of the urinary tract, or who have chronic need for a catheter in the bladder, may be at higher risk of squamous cell carcinoma.
  • Patients with a previous bladder cancer are at increased risk to form new or recurrent bladder tumors.

Other risk factors include diets high in fried meats and animal fats, and older age. In addition, men have a three-fold higher risk than women.

Survival Of Patients With Carcinoma In Situ Of The Urinary Bladder

Liang Cheng M.D.

Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana

Department of Pathology, Mayo Clinic, Rochester, Minnesota

Department of Urology, Mayo Clinic, Rochester, Minnesota

Liang Cheng M.D.

Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana

Department of Pathology, Mayo Clinic, Rochester, Minnesota

Department of Urology, Mayo Clinic, Rochester, Minnesota

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Understanding Your Bladder Cancer Stage

A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The staging system most often used for bladder cancer is the American Joint Committee on Cancer TNM system, which is based on 3 key pieces of information:

  • T describes how far the main tumor has grown through the bladder wall and whether it has grown into nearby tissues.
  • N indicates any cancer spread to lymph nodes near the bladder. Lymph nodes are bean-sized collections of immune system cells, to which cancers often spread first.
  • M indicates if the cancer has spread to distant sites, such as other organs, like the lungs or liver, or lymph nodes that are not near the bladder.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a persons T, N, and M categories have been determined, usually after surgery, this information is combined in a process called stage grouping to assign an overall stage.

The earliest stage cancers are called stage 0 , and then range from stages I through IV .

As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means a more advanced cancer. And within a stage, an earlier letter means a lower stage. Cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

Treating Stage Ii Bladder Cancer

What is CARCINOMA IN SITU? CARCINOMA IN SITU meaning – CARCINOMA IN SITU definition

These cancers have invaded the muscle layer of the bladder wall , but no farther. Transurethral resection is typically the first treatment for these cancers, but it’s done to help determine the extent of the cancer rather than to try to cure it.

When the cancer has invaded the muscle, radical cystectomy is the standard treatment. Lymph nodes near the bladder are often removed as well. If cancer is in only one part of the bladder, a partial cystectomy may be done instead. But this is possible in only a small number of patients.

Radical cystectomy may be the only treatment for people who are not well enough to get chemo. But most doctors prefer to give chemo before surgery because it’s been shown to help patients live longer than surgery alone. When chemo is given first, surgery is delayed. This is not a problem if the chemo shrinks the bladder cancer, but it might be harmful if the tumor continues to grow during chemo.

If cancer is found in nearby lymph nodes, radiation may be needed after surgery. Another option is chemo, but only if it wasn’t given before surgery.

For people who have had surgery, but the features of the tumor show it is at high risk of coming back, the immunotherapy drug, nivolumab, might be offered. When given after surgery, nivolumab is given for up to one year.

For patients who cant have surgery because of other serious health problems, TURBT, radiation, chemotherapy, or some combination of these may be options.

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